Readers, national mental health group push back against Fact Checker story on mass shootings

An impromptu memorial service led by community members takes place in front of the April 16 Memorial in front of Burruss Hall on the Virginia Tech campus on Tuesday., in Blacksburg, Va. (Associated Press)

Sunday’s Fact Checker column has received some pushback from readers. It found the claim that improved mental health care would significantly decrease mass shootings to be mostly untrue and unsupported by evidence.

Below is correspondence from three readers, including the executive director of Mental Illness Policy Org., based in New York City, with my responses.

Criticism #1

Lynne from Winnemucca said, “There is an inherent lack of sanity in mass shooting situations that doesn't necessarily exist in say larcenies or assaults. Although I don't doubt your verdict, the way you arrived there is not convincing.”

Response #1

Regarding the claim that there’s an inherent lack of sanity in mass shootings, I'd say that certainly seems to be the case but where’s the evidence? And even if true, one of the conclusions of the story is that the mental illness might not have been the triggering factor. If not, then we need to be looking at what the actual triggers are. I left out one study from my story about how males’ sense of masculinity causes them to cope poorly with romantic and financial setbacks and it’s this masculinity that was the main trigger in 22 mass shootings analyzed. If true, feminist theory and overturning patriarchy (institutionalized sexism) would seem to be the solution.

Lynne also said the path to my verdict was weak because “ordinary” violent crime is very different than mass murder, and my path focused on violent crime in general. I agree. But the conditions that made my path weak are the same conditions that make the opposite case — better mental health care will significantly decrease mass shootings — also weak. And it’s this weakness behind the examined claim that played a role in my verdict.

Criticism #2

David from Fallon was far harsher. He says that the studies I cited about severe mental illness and violent crime in general have no bearing on mass shootings.

He adds, “Here's what you conveniently omitted: 1. Mental illness is undiagnosed in a significant percentage of the population. 2. Laws to force treatment and/or confinement are relatively weak. 3. The use of psychotropic medication in America is extensive and has risen every year for the last two decades. … Robinson (sic) is correct about the lack of specific statistical information. But, by spinning the nonspecific and unrelated data into his conclusion, Robinson shows that he had already formed an opinion on this subject. Here's a thought: when there aren't enough facts to answer a question, don't try to answer it – and, certainly, don't push your views down our throats.”

Response #2

Here’s a look at claims David said I overlooked:

1. Mental illness is “undiagnosed in a significant percentage of the population.” I haven’t been able to find any statistics to back this up regarding “severe mental illness,” which is what the story is about and is allegedly affecting mass shootings. Please cite a source and I’ll re-examine more in-depth. But even if true, so what? Admittedly, treatment decreases violence among those with severe mental illness. As the story mentioned, even if we wiped out all severe mental illness, 95 percent of violent crime would still occur — and the claim being examined is whether increased mental health care would significantly decrease mass shootings. I haven’t seen any evidence to refute my verdict that better mental health care would not do this.

2. Laws to force treatment/confinement are weak. All I can say is good. Forcing people into an institution against their will — especially when tax increases aren’t being proposed to make sure those institutions aren’t warehouses — is a recipe for abuse. But let’s say you’re right. If you just want to lock up people who are likely mass shooters, mental illness is not as big an indicator as gender (male), age (young adult), race (white) and socioeconomic status (lower). What we’re looking for is causes of mass murder, and mental illness as a cause still hasn’t been established.

3. The use of psychotropic drugs has increased. This doesn’t matter for purposes of the story. The reason for the increase — if true — could be increased diagnoses due to limited understanding of psychosis in the past, the creation of new drugs that are found to work better, increased marketing from drug manufacturers or any number of other reasons.

Regarding David’s claim that I shouldn’t have written about the topic unless there was a definitive answer, this misunderstands the purpose of Fact Checker. I’m looking at a claim made by someone else. That claim was that increased mental health care would significantly decrease mass shootings. I found there’s no evidence to prove it one way or the other, and then I looked at the related issue of violent crime in general. If this second angle had been shown to work, then this might imply it would also work with the specific violent crime of mass murder. It didn’t.

Criticism #3

DJ Jaffe, executive director of Mental Illness Policy Org., wrote to say that my verdict was right — better treatment will not reduce mass shootings — but Jaffe said that the studies I cited didn’t support my conclusion.

His email is so long that I’ve pasted it below for those who would like to read the full thing. But his main points seem to be that I downplayed the increased risk of violence from those with severe mental illness as well as the positive effects of treatment.

I agree that treatment decreases violence. In my first draft, I had a quote from the head of NIMH saying that the chance of violence was 15 times lower after treatment than before for those with severe mental illness. I cut this for space reasons but, in hindsight, I probably should’ve kept it. I ultimately didn’t include it because (1) the amount of violence was still so low that the impact on overall violent crime wouldn’t be significant and (2) when substance abuse was factored out, the rate of violence among those with severe mental illness was no higher than in the general public so substance abuse seems more important to address.

Jaffe singles out for criticism a study I cited on the extreme rarity of being the victim of a violent crime by a stranger with a severe mental illness. I think the study was appropriate. If you’re worried about a stranger with mental illness shooting you — as at a mall, a movie theater or like what happened in Newtown — then the chance of this happening is so rare that you’re 14 times more likely to die of flesh-eating bacteria. This study speaks directly to the fears of the letter writer who prompted the Fact Checker.

Jaffe said he was unaware of the Canadian study I cited regarding those with severe mental illness being responsible for only 3 percent of violent crimes. The related sentence in my story was incorrect; it has been updated online. It found that those with severe mental illness who were not also substance abusers were responsible for only 3 percent of violent crimes. You can find the study here.

While searching for the above link, I found another Canadian report by the same researcher, who found "a causal inference that mental illness causes violence cannot yet be made."

Now if you’d like to read Jaffe’s whole response, which makes a number of very good points, here it is:

Mental Illness and Guns.

Thanks for addressing it. It's a complex issue. We are an organization focused specifically on serious mental illness, not all mental illness. There is a lot of pop-psychology and desire to downplay the relationship of violence to mental illness. This is causing the policies that led to three times more mentally ill being incarcerated than hospitalized.

You asked would better treatment reduce mass shootings? Basically, no. They are way too rare. So you got the question right and that is the most important thing. However, the studies you used did not support your conclusion. If you reexamine similar issues in the future, let us know how we can help. Here is how we would have analyzed the question. (Not to criticize how you did, but we have more expertise in this one narrow area)

Here is how you should analyze the problem.

1. Are mentally ill more violent than others? It depends who is mentally ill.

The 25% of the population you showed are mentally ill are not more violent than others. People like me on zoloft, my neurotic aunt, etc.

But what about the subset of all mentally ill, that are seriously mentally ill

When people ask, "Are mentally ill more violent than others?", they usually mean the seriously ill, not their friends with anxiety, mild depression, eating disorders, ADHD, etc. You came to your conclusion because you analyzed the 25% with any MI, not the 5% with serious mental illness.

You also came to your conclusion because you relied on studies of the treated, like the McArthur Study.

“To “prove” mentally ill are no more violent the McArthur researchers omitted violent people from the study such as persons who were currently in or recently released from a prison, jail, forensic hospital, shelter or long- term psychiatric hospitals. The researchers only included patients released from acute-care hospitals, i.e, patients that were receiving treatment.

They also chose a narrow, high-end definition of violence, that left out many dangerous people. For example, the authors counted as violence only those acts that produced bodily harm. As the father of a woman with schizophrenia and a mean left hook summed it up, "If you're a good ducker, your relative is not considered violent." Or if you ducked the bullet. While most of us would consider setting fires and trashing rooms to be violent acts, the authors of the study did not.

Conversely, the authors chose to study the broad category of mental illness rather than the narrow category of serious mental illness.

Finally, they compared their sample to residents of poor, chaotic, drug-ridden sections of Pittsburgh that had higher crime rates than the city as a whole. That made counts of violence by the subjects seem more ‘normal’ than they would be if compared to the country at large.

The authors still found that over half of the patients studied engaged in some form of threatening behavior within one year after discharge from the hospital. Specifically, 18 per cent of the patients without a drug or alcohol problem committed at least one act of violence (e.g., throwing objects, kicking, hitting, using a weapon) and an additional 33 per cent engaged in at least one act of aggression (same as above except that no harm resulted). Violence was nearly double (31 per cent) among mentally ill people who also abused drugs and alcohol.

The 2009 study you quoted that showed people killed strangers at a rate of 1 to 14 million, was one of the most disingenuous. They limited the study to strangers. The most common victims of mentally ill are families. (I am sorry, I can't put my finger on the study right now, but this gets to it in a roundabout way:

In 25 percent of cases in which an individual killed his/her parent, that individual was mentally ill.

Another problem with some of the studies you quoted is they don't address the question you asked, which was 'will treatment reduce mass shootings'. The study above you relied on, only shows those who actually died, not were victims. In other words, you asked will treatment reduce shootings and then only used statistics that included death.

I do not know which Canadian study you referred to, but I know of no study that says three percent of violence was attributed to those with severe mental illness. 17% of federal prisoners are seriously mentally ill according Bureau of Criminal Justice Statistics. In the US, studies with low numbers are often funded by SAMHSA (DelVecchio). In fact, there is an effort to eliminate SAMHSA because of its refusal as an agency to focus on serious mental illness.

Another trick used in studies, is to attribute any increase in violence among people with serious mental illness to higher levels of substance abuse. The McArthur study did this to a certain extent. But removing those who abuse substances from studies of mental illness related violence, is like removing those who need crutches from studies of those who had knee surgery. Mental illness is a cause of substance abuse as individuals turn to anything they can to try to find release from the hallucinations and delusions that torment them. 5.8 percent of adults without mental illness have a substance use disorder. But among those with mental illness the percentage was three times higher (17.5 percent or 8.0 million adults). And it was four times higher for those who had serious mental illness 22.6 percent. (SAMHSA 2012)

The research is fairly clear. Serious untreated Mental illness is related to an increased propoensity towards violence

A meta-analysis of 204 studies of psychosis as a risk factor for violence reported that “compared with individuals with no mental disorders, people with psychosis seem to be at a substantially elevated risk for violence.” Psychosis “was significantly associated with a 49%–68% increase in the odds of violence.” (Douglas KS 2009).

A review of 22 studies published between 1990 and 2004 “concluded that major mental disorders, per se, especially schizophrenia, even without alcohol or drug abuse, are indeed associated with higher risks for interpersonal violence.” (CC, et al. 2007).

A 2012 study of epidemiological data that included 34,653 people found “Those with serious mental illness, irrespective of substance abuse status, were significantly more likely to be violent than those with no mental or substance use disorders. (Van Dorn, Volavka and Johnson 2012).

Finally, does treatment reduce violence? YEs. I collected the research on just one program in NY

Anyway, I do thank you for looking at the issue. Let us know if you need help. I have a mentally ill sister and as the mental health system has decided to offload the seriously ill to shelters, jails, prisons and morgues, we are trying to bring the needs of the seriously ill back to front and center.

Truthmeter and contact info

Fact Checker columns by Mark Robison are rated on a scale from 0 to 10, with 10 being absolutely true with no gray area, 5 being down the middle with good points by both sides, 1 being false with no gray area and 0 being intentionally, maliciously or foolishly false.

Email factchecker@rgj.com if you've got any queries about claims you've heard people make.